Abstract | BACKGROUND: METHODS: In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies: either PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, or immediate multivessel PCI. The primary end point was a composite of death or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Safety end points included bleeding and stroke. RESULTS: At 30 days, the composite primary end point of death or renal-replacement therapy had occurred in 158 of the 344 patients (45.9%) in the culprit-lesion-only PCI group and in 189 of the 341 patients (55.4%) in the multivessel PCI group (relative risk, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.01). The relative risk of death in the culprit-lesion-only PCI group as compared with the multivessel PCI group was 0.84 (95% CI, 0.72 to 0.98; P=0.03), and the relative risk of renal-replacement therapy was 0.71 (95% CI, 0.49 to 1.03; P=0.07). The time to hemodynamic stabilization, the risk of catecholamine therapy and the duration of such therapy, the levels of troponin T and creatine kinase, and the rates of bleeding and stroke did not differ significantly between the two groups. CONCLUSIONS:
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Authors | Holger Thiele, Ibrahim Akin, Marcus Sandri, Georg Fuernau, Suzanne de Waha, Roza Meyer-Saraei, Peter Nordbeck, Tobias Geisler, Ulf Landmesser, Carsten Skurk, Andreas Fach, Harald Lapp, Jan J Piek, Marko Noc, Tomaž Goslar, Stephan B Felix, Lars S Maier, Janina Stepinska, Keith Oldroyd, Pranas Serpytis, Gilles Montalescot, Olivier Barthelemy, Kurt Huber, Stephan Windecker, Stefano Savonitto, Patrizia Torremante, Christiaan Vrints, Steffen Schneider, Steffen Desch, Uwe Zeymer, CULPRIT-SHOCK Investigators |
Journal | The New England journal of medicine
(N Engl J Med)
Vol. 377
Issue 25
Pg. 2419-2432
(12 21 2017)
ISSN: 1533-4406 [Electronic] United States |
PMID | 29083953
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Topics |
- Aged
- Coronary Artery Disease
(complications, therapy)
- Female
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Myocardial Infarction
(complications, mortality, therapy)
- Percutaneous Coronary Intervention
(methods)
- Renal Insufficiency
(etiology, therapy)
- Renal Replacement Therapy
- Risk
- Shock, Cardiogenic
(etiology, mortality)
- Time-to-Treatment
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